Do you regularly see your doctor for annual checkups, scans, blood tests, and procedures? While most of us see this as a daily part of a healthy lifestyle, Dr. H. Gilbert Welch would suggest otherwise – in fact, he seems to suggest seeing the doctor more frequently can be harmful to your health. In his book, Overdiagnosed: Making People Sick in the Pursuit of Health, he argues over the supposed benefits of today’s commonly accepted medical thoughts: early diagnosis is always better and treatment is always better.
What is overdiagnosis? It’s when you are diagnosed by your doctor with a disease and undergo treatment when you either do not show any symptoms or when treatment might actually be harmful. Can this be you? To be sure, Dr. Welch specifies that he is not against doctors or treatment (he is a doctor, after all), but he is against diagnosing diseases when the patient has yet to show signs of disease. He distinguishes that people who have diseases should be treated, but overdiagnosis is when you are not sure the disease will ever exhibit any symptoms (yes, even some cancers will never affect you) and will never cause any trouble. In such cases, treatment is extremely harmful the patient.
While the message of Overdiagnosed is both thought-provoking and informational, the book has some drawbacks. The structure of the book can grow tiresome and repetitive. As each chapter analyzes one or more diseases (there is a chapter on prostate cancer, followed by breast cancer, and osteoporosis…), Dr. Welch provides detailed information on how each is overdiagnosed. For example, what he mostly considers is the worst case scenario for each disease (cancer being death), and he uses graphs and data to show that the increased number of patients with diagnosis have not affected death rates. This means that the increased health care has not actually benefited more people because it is not saving more lives.
While enlightening, the book grows tedious as you think, yes, overdiagnosis, I get it. Nevertheless, the average person who encounters this book may truly believe that early diagnosis and treatment is the best procedure, and this format helps combat these already established mindsets.
Overdiagnosed ties together key parts of what we consider “common sense” in medical procedures today without necessarily thinking of the benefits to the patients. Why? Dr. Welch lays out several possibilities. Some people genuinely believe that early diagnosis is better (and sometimes it is, but often for 1 person out of hundreds who are overdiagnosed). Many doctors, out of fear of being sued, give you a diagnosis because they can be sued for not finding and treating a potential disease, but they can’t be sued for overdiagnosis. Then think about the people who set the arbitrary numbers for certain diseases – if you are above this number you have it, if you are under it, you don’t. These experts are often tied to pharmaceutical companies. And every time they change that arbitrary disease number, millions more are suddenly patients who require costly medicine or surgeries.
You’ve heard it before and you probably believe it – the myth that preemptive discovery and treatment is best. Its most enticing logo is that it can save your life (and for some extremely lucky few, it can). That’s why you undergo daily or yearly scans (MRIs, mammography, cancer) to reassure yourself that you are disease free (at least for now). However, Dr. Welch cites examples of hellish experiences where an avalanche effect happens where one thing leads to another. Many doctors today see something slightly off on your high tech scan and send you off to do more tests and more scans, maybe even a biopsy – all of which can come back with equally ambiguous data.
You see, more technology actually works against our health in some ways because scans show every tiny abnormality in your body – but all of us have abnormalities! Even though you show no symptoms of any disease, doctors order more tests (each test costing money that will support companies, hospitals, and themselves). You might even undergo surgery just because you really (or the doctors really) feel the need for certainty. Out goes your thyroid and then they perform an absolute biopsy. Whoops! It wasn’t cancer, but it was sure good that we checked, right? Not only does the book include a variety of personal stories of hellish experiences, he shares how some diseases are better left untreated until they begin to show symptoms. The most deadly cancers, for example, are fast growing and often manifest between screening times – and they are so quick that no treatment will help. These are the cancers we all dread. Then there are the slow-growing cancers that, Dr. Welch informs us, are slow-growing and may never harm you or be the cause of death (prostate cancer, unless you are a very old man). In such cases, preemptively finding and treating a slow-growing cancer leaves a patient in far worse health than before.
Overdiagnosed is a key book that calls our attention to how we may all be overtreated and undergo unneeded anxiety through commonly accepted testing. If you don’t believe Dr. Welch, check out the New York Time’s column The Agenda: Health where they discuss the repercussions of too much medical care. Moreover, if you follow health news, you might have heard that ovarian cancer screens are not effective. And if the effectiveness of these scans aren’t convincing enough, read the Time’s article on how skewed the rate of examinations are because they expect most patients to have insurance – but charge the same high rates regardless. The fact that hospitals are so evasive about the cost of tests and procedures suggest to me that they have something to hide.
Dr. Welch seems to have picked up on something that is now receiving widespread attention. Although it is shocking to reevaluate ideas such as “Better safe than sorry” regarding testing, Overdiagnosed really drives home the idea of checking your sources as to whether scanning or even treatment is good for you. I would recommend reading several chapters (or all of it), but until you get the main gist since it can be repetitive. Whether or not you agree with Overdiagnosed, the book offers food for thought about how we engage with medical care today.
What is your take on how much we test ourselves?